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机器人辅助非小细胞肺癌手术治疗的临床疗效和安全性：系统性评价与Meta分析
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Abstract:
背景：本研究旨在评估机器人辅助胸腔手术(RATS)治疗非小细胞肺癌(NSCLC)的安全性和治疗效果。研究设计和方法：检索了PubMed、EMBASE、Cochrane图书馆、Web of Science、CNKI、万方、VIP和CBM，从数据库开始到2022年5月1日。使用Newcastle-Ottawa Scale (NOS)进行质量评估，并使用RevMan (5.4版)进行Meta分析。结果：共纳入19篇文献，包含228,947名患者。与VATS相比，RATS的术中失血较少，淋巴结清扫较多，中间开胸的情况较少，胸腔引流管停留时间较短，术后并发症较少，但费用较高。两组在手术时间、术后总引流量和术后住院时间方面没有明显差异。结论：结果表明，RATS具有术中失血少、组织损伤小、恢复快等优点。在治疗临床非小细胞肺癌时，RTAS是安全可行的。
Background: This study aimed to evaluate the safety and therapeutic effect of robot-assisted tho-racic surgery (RATS) for non-small cell lung cancer (NSCLC). Research design and methods: PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and CBM were searched from da-tabase inception to 1 May 2022. The Newcastle-Ottawa scale (NOS) was used to conduct quality as-sessments, and RevMan (Version 5.4) was used to perform the meta-analysis. Results: A total of 19 publications involving 228,947 patients were included. RATS was associated with less intraopera-tive blood loss, more lymph node dissection, fewer cases of intermediate chest opening, shorter chest drain retention time, and fewer postoperative complications but higher costs compared with VATS. There were no significant differences between the two groups in terms of operative time, total postoperative drainage volume, and postoperative hospital stay. Conclusions: The available evi-dence indicates that the RATS has the advantages of less intraoperative blood loss, minor tissue damage, and quick recovery. In treating clinical non-small cell lung cancer, the RTAS is safely feasi-ble.
| [1] | Sung, H., Ferlay, J., Siegel, R.L., et al. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71, 209-249.
https://doi.org/10.3322/caac.21660 |
| [2] | Siegel, R.L., Miller, K.D. and Jemal, A. (2020) Cancer Statistics, 2020. CA: A Cancer Journal for Clinicians, 70, 7-30.
https://doi.org/10.3322/caac.21590 |
| [3] | Paul, S., Sedrakyan, A., Chiu, Y.L., et al. (2013) Outcomes after Lobectomy Using Tho-racoscopy vs Thoracotomy: A Comparative Effectiveness Analysis Utilizing the Nationwide Inpatient Sample Database. European Journal of Cardio-Thoracic Surgery, 43, 813-817. https://doi.org/10.1093/ejcts/ezs428 |
| [4] | Higuchi, M., Yaginuma, H., Yonechi, A., et al. (2014) Long-Term Outcomes after Video-Assisted Thoracic Surgery (VATS) Lobectomy versus Lobectomy via Open Thor-acotomy for Clinical Stage IA Non-Small Cell Lung Cancer. Journal of Cardiothoracic Surgery, 9, Article No. 88. https://doi.org/10.1186/1749-8090-9-88 |
| [5] | Iwata, S., Hagiwara, A. and Harima, Y. (2020) Thoracoscopic Radical Surgery for a Morbidly Obese Patient with Early Lung Cancer after Laparoscopic sleeve Gastrectomy: A Case Report. Surgical Case Reports, 6, Article No. 189.
https://doi.org/10.1186/s40792-020-00950-6 |
| [6] | Kang, K., Meng, X., Li, B., et al. (2020) Effect of Thoracic Paravertebral Nerve Block on the Early Postoperative Rehabilitation in Patients Undergoing Thoracoscopic Radical Lung Cancer Surgery. World Journal of Surgical Oncology, 18, Article No. 298. https://doi.org/10.1186/s12957-020-02071-8 |
| [7] | Louie, B.E., Wilson, J.L., Kim, S., et al. (2016) Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. The Annals of Thoracic Surgery, 102, 917-924. https://doi.org/10.1016/j.athoracsur.2016.03.032 |
| [8] | Shamseer, L., Moher, D., Clarke, M., et al. (2015) Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: Elaboration and Explanation. The BMJ, 350, G7647.
https://doi.org/10.1136/bmj.g7647 |
| [9] | Cumpston, M., Li, T., Page, M.J., et al. (2019) Updated Guidance for Trusted Systematic Reviews: A New Edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database of Systematic Re-views, 10, Article No. ED000142. https://doi.org/10.1002/14651858.ED000142 |
| [10] | Hozo, S.P., Djulbegovic, B. and Hozo, I. (2005) Estimating the Mean and Variance from the Median, Range, and the Size of a Sample. BMC Medical Research Methodology, 5, Article No. 13. https://doi.org/10.1186/1471-2288-5-13 |
| [11] | Seder, C.W., Farrokhyar, F., Nayak, R., et al. (2022) Robotic vs Thoracoscopic Anatomic Lung Resection in Obese Patients: A Propensity-Adjusted Analysis. The Annals of Thoracic Surgery, 114, 1879-1885.
https://doi.org/10.1016/j.athoracsur.2021.09.061 |
| [12] | Zheng, L., Song, P., Jiang, Y., et al. (2022) Outcomes and Quality of Life after Robot-Assisted Lobectomy/Segmentectomy for Lung Cancer Compared to Video-Assisted Thoracoscopic Surgery: Both Three-Port Procedures Performed by a Single Surgeon. Journal of Thoracic Disease, 14, 689-698. https://doi.org/10.21037/jtd-22-238 |
| [13] | Zhang, F., Xu, L., Lu, H.D., Ma, A.Q. and Wang, G.C. (2022) Short-Term Surgical Outcomes for Lobectomy between Robot-Assisted Thoracic Surgery and Uniportal Video-Assisted Thoracoscopic Surgery. Frontiers in Oncology, 12, Article 914059. https://doi.org/10.3389/fonc.2022.914059 |
| [14] | Qu, C., Li, R., Ma, Z., et al. (2022) Comparison of the Perioperative Outcomes between Robotic-Assisted Thoracic Surgery and Video-Assisted Thoracic Surgery in Non-Small Cell Lung Cancer Patients with Different Body Mass Index Ranges. Translational Lung Cancer Research, 11, 1108-1118. https://doi.org/10.21037/tlcr-22-137 |
| [15] | Montagne, F., Chaari, Z., Bottet, B., et al. (2022) Long-Term Survival Following Min-imally Invasive Lung Cancer Surgery: Comparing Robotic-Assisted and Video-Assisted Surgery. Cancers (Basel), 14, Article 2611.
https://doi.org/10.3390/cancers14112611 |
| [16] | Li, R.Y., Ma, Z., Li, Y.Z., et al. (2022) Robotic-Assisted Thoracoscopic Surgery Improves Perioperative Outcomes in Overweight and Obese Patients with Non-Small-Cell Lung Cancer Undergoing Lobectomy: A Propensity Score Matching Analysis. Thoracic Cancer, 13, 2606-2615. https://doi.org/10.1111/1759-7714.14597 |
| [17] | Jin, R., Zheng, Y., Yuan, Y., Han, D., et al. (2022) Robotic-Assisted versus Video-Assisted Thoracoscopic Lobectomy: Short-Term Results of a Randomized Clinical Trial (RVlob Trial). Annals of Surgery, 275, 295-302.
https://doi.org/10.1097/SLA.0000000000004922 |
| [18] | Jian, Z., Li, C., Feng, X., et al. (2022) Robotic versus Thoracoscopic Combined Anatomic Subsegmentectomy for Early-Stage Lung Cancer: Early Results of a Cohort Study. Journal of Thoracic Disease, 14, 1441-1449.
https://doi.org/10.21037/jtd-21-1895 |
| [19] | Chen, D.L., Kang, P.M., Tao, S.L., et al. (2022) Comparative Short-Term Outcomes of Robotic-Assisted Surgery for Older Patients with Non-Small Cell Lung Cancer: A Propensity Matched Study. Updates in Surgery, 74, 1087-1096.
https://doi.org/10.1007/s13304-021-00992-x |
| [20] | Veronesi, G., Abbas, A.E., Muriana, P., et al. (2021) Perioperative Outcome of Robotic Approach versus Manual Videothoracoscopic Major Resection in Patients Affected by Early Lung Cancer: Results of a Ran-domized Multicentric Study (ROMAN Study). Frontiers in Oncology, 11, Article 726408. https://doi.org/10.3389/fonc.2021.726408 |
| [21] | Huang, J., Tian, Y., Zhou, Q.J., et al. (2021) Comparison of Perioperative Out-comes of Robotic-Assisted versus Video-Assisted Thoracoscopic Right Upper Lobectomy in Non-Small Cell Lung Cancer. Transla-tional Lung Cancer Research, 10, 4549-4557. https://doi.org/10.21037/tlcr-21-960 |
| [22] | Haruki, T., Takagi, Y., Kubouchi, Y., et al. (2021) Comparison between Robot-Assisted Thoracoscopic Surgery and Video-Assisted Thoracoscopic Surgery for Mediastinal and Hilar Lymph Node Dissection in Lung Cancer Surgery. Interactive CardioVascular and Thoracic Surgery, 33, 409-417. https://doi.org/10.1093/icvts/ivab112 |
| [23] | Zhou, Q., Huang, J., Pan, F., et al. (2020) Operative Outcomes and Long-Term Sur-vival of Robotic-Assisted Segmentectomy for Stage IA Lung Cancer Compared with Video-Assisted Thoracoscopic Segmentectomy. Translational Lung Cancer Research, 9, 306-315. https://doi.org/10.21037/tlcr-20-533 |
| [24] | Zhang, Y.J., Chen, C., Hu, J., et al. (2020) Early Outcomes of Robotic versus Thoracoscopic Segmentectomy for Early-Stage Lung Cancer: A Multi-Institutional Propen-sity Score-Matched Analysis. The Journal of Thoracic and Cardiovascular Surgery, 160, 1363-1372. https://doi.org/10.1016/j.jtcvs.2019.12.112 |
| [25] | Sesti, J., Langan, R.C., Bell, J., et al. (2020) A Comparative Analysis of Long-Term Survival of Robotic versus Thoracoscopic Lobectomy. The Annals of Thoracic Surgery, 110, 1139-1146.
https://doi.org/10.1016/j.athoracsur.2020.03.085 |
| [26] | Lee, E.C., Lazzaro, R.S., Glassman, L.R., et al. (2020) Switching from Thoracoscopic to Robotic Platform for Lobectomy: Report of Learning Curve and Outcome. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery (Phila), 15, 235-242. https://doi.org/10.1177/1556984520911670 |
| [27] | Cui, Y., Grogan, E.L., Deppen, S.A., et al. (2020) Mortality for Robotic- vs Video-Assisted Lobectomy-Treated Stage I Non-Small Cell Lung Cancer Patients. JNCI Cancer Spectrum, 4, pkaa028. https://doi.org/10.1093/jncics/pkaa028 |
| [28] | Bao, F., Zhang, C., Yang, Y., et al. (2016) Comparison of Robotic and Video-Assisted Thoracic Surgery for Lung Cancer: A Propensity-Matched Analysis. Journal of Thoracic Disease, 8, 1798-1803.
https://doi.org/10.21037/jtd.2016.05.99 |
| [29] | Mungo, B., Hooker, C.M., Ho, J.S., et al. (2016) Robotic versus Thoracoscopic Resection for Lung Cancer: Early Results of a New Robotic Program. Journal of Laparoendoscopic & Advanced Surgical Techniques, 26, 243-248.
https://doi.org/10.1089/lap.2016.0049 |
| [30] | Novellis, P., Bottoni, E., Voulaz, E., et al. (2018) Robotic Surgery, Video-Assisted Thoracic Surgery, and Open Surgery for Early Stage Lung Cancer: Comparison of Costs and Outcomes at a Single Institute. Journal of Thoracic Disease, 10, 790-798. https://doi.org/10.21037/jtd.2018.01.123 |
| [31] | Cerfolio, R.J., Bess, K.M., Wei, B. and Minnich, D.J. (2016) Incidence, Results, and Our Current Intraoperative Technique to Control Major Vascular Injuries during Minimally Inva-sive Robotic Thoracic Surgery. The Annals of Thoracic Surgery, 102, 394-399. https://doi.org/10.1016/j.athoracsur.2016.02.004 |
| [32] | Worrell, S.G., Dedhia, P., Gilbert, C., et al. (2019) The Cost and Quality of Life Outcomes in Developing a Robotic Lobectomy Program. Journal of Robotic Surgery, 13, 239-243. https://doi.org/10.1007/s11701-018-0844-z |
| [33] | Moore, L.J., Wilson, M.R., Waine, E., et al. (2015) Robotic Technology Results in Faster and More Robust Surgical Skill Acquisition than Traditional Laparoscopy. Journal of Robotic Surgery, 9, 67-73.
https://doi.org/10.1007/s11701-014-0493-9 |
| [34] | Liu, X., Xu, S., Liu, B., et al. (2018) Survival Analysis of Stage I Non-Small Cell Lung Cancer Patients Treated with ？Da Vinci Robot-Assisted Thoracic Surgery. Chinese Journal of Lung Cancer, 21, 849-856. |
| [35] | Wei, B. and D’Amico, T.A. (2014) Thoracoscopic versus Robotic Approaches: Advantages and Disadvantages. Tho-racic Surgery Clinics, 24, 177-188. https://doi.org/10.1016/j.thorsurg.2014.02.001 |
